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In our day to day lives, most of us experience about something called “skin pigmentation”.We try cosmetic remedies, home remedies, curse the sun and the think of it to be dust and dirt debris. But, did we ever think that skin pigmetation may have a relevance with our health status??

 

 

Acanthosis nigricans (AN) is a skin condition characterized by abnormally increased coloration (hyperpigmentation) and “velvety” thickening (hyperkeratosis) of the skin, particularly of skin fold regions, such as of the neck and groin and under the arms (axillae).

Various benign (non-cancerous) forms of AN have been identified in which

  • the disorder may be inherited as a primary condition
  • or associated with various underlying syndromes, an excess accumulation of body fat (obesity),
  • or the use of certain medications (i.e., drug-induced AN).

CAUSES

                                                 

  1. GENETICALLY INHERITED-autosomal dominant trait.Only needs atleast one parent to inherit gene to the child.
  2. diabetes
  3. obesity
  4. PCOS
  5. Addison disease
  6. parapsoriasis
  7. becker naevus
  8.  Lymphoma, ADENOCARCINOMA git,genitourinary tract
  9. DRUG INDUCED— oral contraceptives, GH

Signs and Symptoms

  •  increased coloration or pigmentation (hyperpigmentation)
  • and abnormal thickening of the skin.
  • The most commonly affected areas:
  1. include the sides and back of the neck,
  2. under the arms (axillae),
  3. the groin,
  4. and the anal/genital region.
  •          

5.In some instances, other body fold , such as behind the knees, in front of the elbows, under the breasts, and/or the navel (umbilicus) region. There have also been some reports in which almost all of the skin is affected.

 

 Initial changes may include the development of greyish brown or black pigmentation, excessive roughness and dryness, and noticeable thickening or overgrowth (hyperkeratosis) of the skin. Affected areas are covered with relatively small, elevated, “warty” (verrucous) tissue growths (papillomatous elevations), resulting in an unusual, velvety texture. With increasing skin thickening, regional skin lines become more accentuated, the skin surface may appear unusually wrinkled or ridged; and larger, wart-like outgrowths develop.

It is of two types:

  • BENIGN AN
  • MALIGNANT AN

 

BENIGN AN

Benign AN may occur as a primary, isolated condition (known as hereditary benign AN) or be associated with various underlying disorders, conditions, or syndromes.  In some cases of benign AN, associated skin abnormalities may be present at birth (congenital). However, they more commonly appear during childhood or puberty. The skin changes tend to develop slowly, may worsen during adolescence, and eventually stabilize or improve.

A benign variant of AN has also been described in which the condition occurs as a reversible skin manifestation associated with obesity. Known as “pseudoacanthosis nigricans,”Associated findings include relatively small regions of increased pigmentation and thickening as well as outgrowths of skin (skin tags) in body folds, particularly the groin, under the arms, and the cleft between the buttocks where the anus opens (anal or natal cleft) 

MALIGNANT AN

 This form of the condition is most common in adults, particularly those over age 40, and appears to affect men and women relatively equally. The underlying malignancy is often derived from glandular tissue (adenocarcinoma), particularly of the stomach (gastric adenocarcinoma), or, less commonly, the intestines, pancreas, uterus, lung, ovary, bladder, breast, or prostate. Rarely, AN may occur in association with malignancy of the lymphatic system (lymphoma).

Skin changes are typically more extensive and severe than seen in benign AN. Findings may include thickening, unusual roughness and dryness, and/or potentially severe itching (pruritus) and irritation of affected skin regions. Pigmentary changes may be more pronounced than seen in benign AN and are not restricted to areas of hyperkeratosis. Malignant AN is also frequently associated with involvement of the mucous membranes and distinctive abnormalities of the mouth (oral) region. 

Malignant AN is also commonly characterized by

  • wart-like thickening around the eyes;
  • unusual ridging or brittleness of the nails;
  • thickening of the skin on the palms of the hands;
  • hair loss

Affected Populations

Acanthosis nigricans is a condition that may become apparent at any age. Many benign forms develop during childhood or puberty, while the onset of malignant AN, most frequently occurs after 40 years of age.

 Another study of obese adults found that among patients weighing at least twice their “ideal body weight” more than 50 percent showed evidence of AN.

Related disorders

DIABETES

A skin manifestation of insulin resistance, which is a condition characterized by impaired biological responses to insulin.

 

 

Insulin, a hormone produced by the pancreas, regulates blood glucose levels by promoting the movement of glucose into cells for energy production or into the liver and fat cells for energy storage. (Glucose is a simple sugar that is the body’s primary source of energy for cell metabolism.) Some clinicians suggest that insulin resistance causes a build-up of the hormone in the blood and then it finds its way into skin cells. Insulin resistance may be associated with various disorders, including obesity and non-insulin-dependent (type II) diabetes mellitus. In individuals with type II diabetes mellitus, the pancreas produces insulin but the body becomes resistant to its effects, leading to insufficient absorption of glucose and abnormally increased glucose levels in the blood (hyperglycemia) and urine. As a result, there may be a gradual onset of certain symptoms, including excessive urination (polyuria) and increased thirst (polydipsia), and the development of particular complications without appropriate treatment.

Addison’s disease

Addison’s disease is an endocrine or hormonal disorder that occurs in all age groups and afflicts men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and non-exposed parts of the body.

Addison’s disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone. The disease is also called adrenal insufficiency, or hypocortisolism.  Among its other vital tasks, cortisol helps balance the effects of insulin in breaking down sugar for energy. 

Becker nevus

Becker nevus is a late-onset birthmark occurring mostly in males. It is also known as Becker melanosis. It is due to an overgrowth of the epidermis (upper layers of the skin), pigment cells (melanocytes) and hair follicles. It develops during childhood or adolescence on the shoulders or upper trunk, occasionally elsewhere. It is thought that it is due to a gene defect, which has not yet been identified. It may be triggered by circulating androgens (male hormones such as testosterone), which is why it appears in males at puberty.

A Becker nevus is a large one-sided brown patch, sometimes observed over half the upper back or chest. After puberty it often becomes darker and quite hairy, a feature also called hypertrichosis.

Ichthyosis hystrix

Ichthyosis hystrix is a rare inherited skin disorder. It is characterized by scaling skin (ichthyosis) ranging from mild to severe. Thick, horny skin (keratoderma) on the palms of the hands and the soles of the feet may occur with no other symptoms, or the whole body surface may be covered with scales. 

Parapsoriasis en plaque

Parapsoriasis en plaque is also known as chronic superficial scaly dermatitis (CSSD), or chronic superficial dermatitis, or digitate dermatosis. It is an uncommon chronic skin condition characterized by round or oval red, slightly scaly patches on limbs and trunk. Chronic superficial scaly dermatitis mostly affects adults especially men. The cause is unknown.

Chronic superficial scaly dermatitis begins insidiously with one or more red, slightly scaly patches. The commonest site is on the lower limbs, but the trunk and upper limbs are often affected. It is seldom seen on the face, palms or soles.

DIAGNOSIS

  • CLINICAL EVALUATION
  • PHYSICAL FINDINGS
  • PATIENT HISTORY
  • FAMILY HISTORY
  • DRUG HISTORY
  • PLASMA INSULIN LEVELS
  • PLASMA CORTISOL
  • BLOOD GLUCOSE
  •  URINE GLUCOSE
  • ANTIBODIES– INSULIN RECEPTORS, OTHER AUTOIMMUNE DISEASES

TREATMENT

AN may resolve with therapy directed toward correcting or managing an underlying disorder or other causative condition,

  • Appropriate hormone replacement therapy for those with certain endocrine disorders; removal of medications that may cause drug-induced AN,

 

  •  In addition, in some cases, such as for those with insulin resistance associated with diabetes mellitus, disease management may include making appropriate dietary adjustments; regularly monitoring blood levels; taking certain medications by mouth (orally), receiving appropriate insulin replacement therapy; and/or other measures.

                   

  • For those with pseudoacanthosis nigricans, sufficient weight loss under a physician’s care may improve certain skin changes associated with AN. 

 

  • For some with AN, recommended treatment may include the use of certain synthetic, vitamin A-like compounds (retinoids) administered by mouth or applied to the skin (topically). 

 

 

  • For individuals with malignant AN, disease management requires treatment by cancer specialists (oncologists),

 

  • recommended treatment may include surgical removal of the malignancy; administration of certain anticancer drugs (chemotherapy); radiation therapy, and/or other measures.

 

  • Genetic counseling may sometimes be of benefit for affected individuals and their families (e.g., for those with hereditary benign AN, or other underlying genetic causes of AN).
  • HOME REMEDIES–
  • LOOSING WEIGHT HAVE KNOWN TO BE EFFECTIVE AND SIGNIFICANT SKIN CHANGES especially in PSEUDOACANTHOSIS NIGRICANS.

 

 

 

ALTHOUGH SKIN PIGMENTATION CAN TELL ABOUT REALLY SERIOUS HEALTH CONDITIONS BUT WITH TIMELY IDENTIFICATION ,INTERVENTION AND LIFESTYLE CHANGES-MANY OF THE CHANGES ARE PREVENTABLE AND REVERSIBLE.

 

REFERENCES-

rarediseases.org

 

 

 

–HARSHITA MISHRA (SRMS IMS BAREILLY)

–SIRAJ AHMAD (GMC BADAUN)


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